RCH logo

Allergy and Immunology

Allergy

  • What is an allergic reaction?

    An allergy develops when the immune system recognises and responds to something in the environment that is normally harmless: e.g. food proteins, pollens or dust mite.  An allergic reaction occurs when a child is exposed to that substance and the body's immune system reacts to that substance.  Symptoms may be localised or generalised, and range from mild to severe.

    The most common causes of allergic reactions in young children are foods. In particular:

    • Egg
    • Cow's milk
    • Peanut
    • Tree nut
    • Soy
    • Wheat
    • Fish
    • Shellfish
    • Sesame
    • Lupin

    Other causes are bee or other insect stings (wasps, jack jumper ants), medication and latex (rubber).

    What is anaphylaxis?

    This term is used to describe a severe allergic reaction that involves the respiratory and/or cardiovascular systems.  Anaphylaxis is the most severe form of an allergic reaction and is life threatening.

    A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline autoinjector (Epinephrine). An important aspect of anaphylaxis management is prevention and avoidance of the cause.

    Signs and symptoms of an allergic reaction:

    Mild to moderate allergic reaction 

    A mild to moderate reaction will include one or more of these symptoms, and it is possible that a number of them will occur simultaneously:

    • Swelling of lips, face & eyes
    • Hives or welts
    • Tingling mouth
    • Abdominal pain, vomiting (these are signs of anaphylaxis for insect allergy)

    Mild to moderate allergic reactions may not always occur before anaphylaxis

    Anaphylaxis 

    Anaphylaxis is the term used to describe a severe systemic allergic reaction that involves the respiratory and/or cardiovascular system.

    Presentation of any one of the following symptoms below indicates anaphylaxis:

    • Difficult/noisy breathing
    • Swelling of tongue
    • Swelling/tightness in throat
    • Difficulty talking and/or hoarse voice
    • Wheeze or persistent cough
    • Persistent dizziness or collapse
    • Pale and floppy (young children)

    Management of anaphylaxis

    Treatment of anaphylaxis

    The first line emergency treatment for anaphylaxis is adrenaline (Epinephrine), all children who have experienced anaphylaxis should be prescribed an adrenaline autoinjector. EpiPen® is currently the only adrenaline autoinjector available for use in Australia. EpiPen Jr® is prescribed for children weighing between 7.5 - 20 kg, EpiPen® is prescribed for children weighing 20 kg or more. EpiPen® is a single use single dose of adrenaline, and needs to be prescribed initially by an allergist. 

    Once prescribed by an allergist, a GP can prescribe adrenaline autoinjector and update the ASCIA action plan for anaphylaxis .

    Care of the EpiPen®/EpiPen® Jr 

    • Clearly label storage container with child's name and photo
    • Check expiry date regularly
    • Store at room temperature
    • Store in a safe, easily accessible location
    • A copy of the ASCIA action plan for anaphylaxis should be stored with the EpiPen®/EpiPen® Jr,  which must be followed in the case of emergency.
    • The ASCIA action plan for anaphylaxis also contains contact details for parents/guardian, and medical services

    Each child who has been prescribed an EpiPen®/EpiPen® Jr, requires an ASCIA action plan for anaphylaxis , completed by a doctor or clinical nurse practitioner. A copy of the ASCIA action plan for anaphylaxis should be provided to schools and children's services by the parents, together with an EpiPen®/EpiPen® Jr.

    • School & Children's Services staff are required to have  anaphylaxis training and be competent in the use of an adrenaline autoinjector (EpiPen®)
    • If a reaction is suspected, the ASCIA action plan for anaphylaxis must be followed
    • If an EpiPen®/EpiPen® Jr, is given, an ambulance must be requested by phoning 000 * Medical observation in hospital for at least 4 hours is recommended after anaphylaxis
    • If in doubt, give adrenaline autoinjector

    Prevention of subsequent allergic reactions:

    • Know and avoid the causes
    • Do not allow food sharing or swapping
    • Only give foods approved by the child's parents
    • Use non-food treats where possible, but if food treats are used, give only those provided by the parents (encourage parents to provide a container of safe treats from home)
    • Practise routine hygiene and good food safety practices. Children and staff should always wash their hands after play and before and after eating.

    Banning of products

    Banning of products that contain the allergen is NOT recommended.

    Banning will not succeed in creating an "allergy free zone".  It is difficult to achieve a 100% ban, for a variety of reasons.  For example, product labels can be confusing, parents of non-allergic children may not comply with the ban, and lastly, staff and students become complacent.

    Food sharing

    The child at risk of food allergies should not share food.  These children must only have food provided from home or given with the parent's permission.

    Food preparation

    Any staff, including relief staff, who are responsible for cooking or delivering food to children should know about the child's allergies.  They should be aware of alternative words used to describe the particular allergy food.  For example, cow's milk may be called casein, and egg may be called ovalbumin.  They should also be aware of potential contamination of other foods when preparing, handling or displaying food.

    Art/craft

    Food containers or packages that contain the allergen should not be used.  

    Separate tables should be used for art/craft and food.  Where this is not possible, tables must be cleaned thoroughly between use.

    Excursions/camps

    The EpiPen®/EpiPen® Jr must be taken on all excursions and staff must have had anaphylaxis training and be competent in use of an adrenaline autoinjector (EpiPen®)

    The EpiPen®/EpiPen® Jr must be readily available. An adrenaline autoinjector for general use should be taken on all excursion/camps